“To Fee or Not to Fee” — Considerations and Concerns

Brokers have been buffeted by the myriad changes occurring at record pace over these past few years. The Affordable Care Act (ACA) has had a dramatic impact on the types of health insurance products available, the scope of benefits offered and how brokers are compensated for the valuable services they provide.

Many brokers have transformed their practices with an emphasis on becoming a consultant to their clients – individual and group. As a consultant, brokers are expanding the scope of the traditional sales-related assistance.

Recent guidance from CMS clarified that brokers can charge fees in the Federal marketplace for the extra value that they are providing to clients. The guidance, in the form of a Q& A, establishes that brokers must clearly disclose the amount and reason for a fee while also informing consumers that they can apply for coverage on their own without a fee through Healthcare.gov. Here is the full-text of the guidance.

A broker wishing to establish a fee-based practice must consider a number of other factors before implementing this change. Chief among these is whether state law allows a broker to charge a fee, the rules surrounding the charging of fees and whether a separate consulting license is required. NAHU has compiled a chart that provides some information on a state-by-state basis regarding relevant state laws. It is recommended that a broker verify whether fees may be charged and any related requirements through their insurance commissioner before taking steps.

Why are some brokers considering fee-based practices? Some are adding valuable services that exceed the selection and placement of insurance coverage. Others see a fee-based business as a reaction to changing commission structures, providing more predictability to revenue streams.

Determining how much to charge and what the scope of services the fee will purchase isn’t easy. For many consultants, fee setting is one of the more difficult decisions to make. Then, becoming accustomed to discussing fees and services with clients is another hurdle. Some considerations for fee setting, if allowed by law, include:

  • Fees plus commission on commissionable products
  • Fees only on non-commissionable products
  • Reflection of hours worked
  • Past revenue basis
  • Increased revenue basis
  • Loss leader
    • Nominal fee
    • Profits made in follow-on sales of products or services.

“To fee or not to fee” is a decision that can’t be made lightly and it must be made after reflection and planning. For products where commissions have been the practice, one must be able to make the case to the consumer that the services provided exceed those of the other brokers who have maintained a traditional commission-based practice.